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NPI Code Detail

MEDICARE: MS. KRISTY L. MOORE MSW

MEDICARE: MS. KRISTY L. MOORE MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801084770MI

General Provider Information

NPI Number : 1619918869
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRISTY L. MOORE MSW
Provider Business Mailing Address
First Line : 2633 N PETERSON DR
Second Line :
City : SANFORD
State : MI
Zip : 48657-9487
Country : US
Telephone Number : 989-687-7859
Fax Number :
Provider Business Practice Location Address
First Line : 201 MULHOLLAND ST
Second Line :
City : BAY CITY
State : MI
Zip : 48708-7693
Country : US
Telephone Number : 989-895-2205
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 07/08/2007

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